TalkHealth, Sense About Science and Thyroid Disease

[Guest guest]

I don't know if anyone has seen this excellent post

http://www.talkhealthpartnership.com/forum/viewtopic.php?t=2135 on TalkHealth about their partnership with Sense About Science's Ask for Evidence Campaign

http://www.senseaboutscience.org/pages/a4e.html and the responses it invoked. I am wondering if this shouldn't be put on the Talking with Doctors section so that they can all see it. They will no doubt go into hiding but at least it will be out in the public.LoveJacquie I find it interesting that your organisations have teamed up with Sense About Science. Sense About Science's Ask For Evidence campaign suggests that sometimes evidence in healthcare can be presented in biased ways. Do you think that endocrinologists should have any responsibility or obligation to present information about thyroid disease and its treatments to GPs and patients, in an objective and transparent manner? As it stands, your organisations do not supply references to evidence many of the points in your (2011) statement and on the SfE's patient information website. Example 1"the inclusion of T3 in the treatment of hypothyroidism should be reserved for use by accredited endocrinologists in individual patients." (2011)Are there any published, peer-reviewed RCTs that directly compare clinical outcomes for patients treated with T3 + T4 combination treatments in the following treatment groups: accredited endocrinologists versus doctors who are not accredited endocrinologists? How do we as patients know that the above assertion doesn't just arise from professional protectionism or territorialism? Where the level of evidence your organisations have for any given assertion is G.O.B.S.A.T. then would it not be more transparent to make it abundantly clear that your organisations' assertions are based solely on the opinions of a select (self-selecting? Voted for? Representative?) committee and that there is a lack of any good quality evidence? That way GPs and patients can give appropriate weighting to those assertions.Example 2"We do not recommend the prescribing of additional tri-iodothyronine (T3) in any presently available formulation, including Armour Thyroid, as it is inconsistent with normal physiology…"(2011)The human thyroid gland produces mostly T4 and a very small amount of T3. Unless the inhabitants of Britain have been shown to have uniquely evolved thyroid glands that produce only T4 (is there any evidence for this?), all of the available replacement treatments as currently formulated (T3+T4, Armour or Levothyroxine-only) are `inconsistent with normal physiology'.Why then do your organisations highlight this problem when disparaging combination T3 + T4 treatments but fail to mention it when praising T4-only treatment?A biased presentation of information may (inadvertently I'm sure) be misleading to patients, who may think that they are getting a replacement hormone in T4-only treatment that is not `inconsistent with normal physiology'.Would it not be more accurate and transparent to say: "None of the currently available treatments are consistent with `normal physiology' however we promote the use of Levothyroxine for all patients based only on the limited types of evidence we are willing to consider etc."?These are just two examples, but there are so many more in your organisations' publications. As a patient I would like to be presented with objective (and not agenda-driven) information so that I can give informed consent. GPs are busy and can't be expected to chase up references to scrutinize the legitimacy of your assertions.As promoters of the Ask For Evidence campaign, do you think that your endocrine organisations might strive to set a good example and offer a firm commitment to providing transparent, open, referenced, objective and accountable information to patients and GPs?